Placebos in 19th century medicine: a quantitative analysis of the BMJ
(Published 18 December 2012)
Cite this as: BMJ 2012;345:e8326
- 1Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- 2University of New England College of Osteopathic Medicine, Biddeford, ME 04005, USA
- Correspondence to: T J Kaptchuk
- Accepted 27 November 2012
Objective To provide the first quantitative data on the use of the term “placebo” in the 19th century.
Design Computer search of BMJ’s archival database from January 1840 (the first issue) through December 1899 for uses of the words “placebo(s).” Grounded theory was used to categorise the implications of uses of the term.
Results 71 citations contained the term “placebo(s).” Of these, 22 (31%) used the term to mean “no effect” or as a general pejorative term, 18 (25%) portrayed placebo treatment as permitting the unfolding of the natural history (the normal waxing and waning of illness), 14 (20%) described placebo as important to satisfy patients, 7 (10%) described it as fulfilling a physician’s performance role, 3 (4%) described its use to buy time, 3 (4%) described its use for financial gain, 2 (3%) used it in a manner similar to a placebo control, and only one implied that placebo could have a clinical effect. Only one citation mentioned telling the patient about his placebo treatment.
Conclusion Nineteenth century physicians had diverse a priori assumptions about placebos. These findings remind us that contemporary medicine needs to use rigorous science to separate fact from its own beliefs concerning the “provision of care.” As in previous generations, ethical issues concerning placebos continue to challenge medicine.
We thank Iain Chalmers for advice.
Contributors: TJK and JER designed the study, analysed the data, and prepared the manuscript. BHS analysed the data and contributed to the manuscript. TJK is the guarantor.
Funding: The paper is supported in part from NIH NCCAM grants K24 AT004095, R01 AT004662, R01AT005280, R01 AT006364, and P01 AT006663.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
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